What Do We Mean When We Say a Patient is Suffering? A Philosophical and Theological Reframing​Tyler Tate, MD, MA, Assistant Professor of Pediatrics; Attending Physician, Pediatric and Adult Palliative Care; and Senior Scholar, Center for Healthcare Ethics, Oregon Health and Science University.

What is suffering? What is its relationship to medicine?

These are not easy questions. It is uncontroversial to claim that the alleviation of suffering is central to the goals of medicine. Yet, while many of medicine’s actions are grounded in a desire to decrease suffering, the nature of suffering remains vague and difficult to articulate. Is suffering the result of physical pain, or is it the pain itself? Can a person be blind to their own suffering? Must suffering be associated with a discernible event, such as disease, poverty, or the loss of a loved one, or can it be a solely subjective and internal affair? What distinguishes suffering from grief, depression, ennui, or despair? Or are these “feelings” simply different expressions of human suffering?

This paper will elucidate some of these complex questions. The objectives of this paper then are threefold. First, to analyze the phenomenon of suffering and critique its dominant conceptualizations, with a focus on the influential work of Eric Cassell. Second, to provide a novel, patient-centric, conceptual framework for understanding suffering in the healthcare context. Within this framework there are two necessary conditions: (1) a loss of a person’s sense of self, which is realized as a loss of one’s relationships, roles, or narrative, and (2) a negative affective experience. These two objectives are the topic of a paper currently in press for publication in the journal Perspectives in Biology and Medicine.The third objective is to situate suffering within the Christian story by drawing on the diverse theological insights of Allen Verhey, John Swinton, Paul Ramsey, and Janet Martin Soskice. By reframing the identity of the suffering patient as (1) an image-bearer of God (2) a neighbor, it will become evident that patient suffering requires a theological reimagining in order that the claim suffering patients have on clinicians be fully realized and compassionate care fully actualized. The paper will conclude with several brief, practical suggestions for how clinicians can use this framework and theological reimagining to more effectively address and alleviate patient suffering in the clinical setting.